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Made-in-Canada HIV strategy embraced internationally — but not here

A made-in-Canada strategy for fighting HIV/AIDS is being embraced internationally, but Ottawa refuses to adopt it.

The Treatment as Prevention strategy, pioneered in B.C., calls for the immediate provision of highly effective antiretroviral therapy to those living with HIV. (CHARLA JONES / TORONTO STAR) | Order this photo

By Julio Montaner

Sun., Dec. 1, 2013

As Canadians, we should be proud on World AIDS Day that our country is the birthplace of a pioneering strategy that significantly reduces HIV transmission rates, improves and saves the lives of those infected, and saves public health dollars. At the same time, it’s shameful that this scientifically proven program — supported by the government of British Columbia — is being adopted internationally but not in Canada.

The Treatment as Prevention strategy, pioneered in B.C., calls for widespread HIV testing and immediate provision of highly effective antiretroviral therapy to those living with HIV. Such treatment can eliminate progression of HIV infection to AIDS and premature death, and significantly decrease the amount of virus in the blood and sexual fluids, thereby stopping transmission of HIV.

This past week, the government of B.C. and the B.C. Centre for Excellence in HIV/AIDS signed a memorandum of understanding with China to extend the use of the Canadian strategy in that country. The agreement marks the formalization of a strong three-year relationship with China, the first country to adopt Treatment as Prevention as its national HIV/AIDS policy. Earlier this year, China announced that it had surpassed its HIV detection and treatment goals since adopting Treatment as Prevention.

Meanwhile, B.C. remains the only jurisdiction in Canada to use this strategy and promote widespread and fully government-supported access to HIV testing and life-saving drug therapy. And, importantly, B.C. remains the only province to demonstrate a significant and consistent decline in new cases of HIV.

In contrast to a growing list of countries and international organizations, Ottawa has chosen not to adopt Treatment as Prevention as the national strategy to fight HIV and AIDS. This short-sighted approach has led Canadian provinces to unnecessarily carry the burden of new infections and costs. According to new research, there is no material decrease in HIV rates in Canada outside of B.C. Annual rates of new HIV diagnoses in Saskatchewan and Manitoba increased; rates remained unchanged in Alberta and in the Territories; and rates declined only slightly in Ontario, Quebec and the Atlantic provinces.

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China is no longer the only country embracing our made-in-B.C. Treatment as Prevention model. In October, France and Brazil both announced adoption of the strategy as their national policies. And the World Health Organization fully incorporated Treatment as Prevention in their new Global HIV Treatment Guidelines.

The U.S. has also identified ours as a key strategy to achieve an AIDS-free generation. This month, U.S. senators and members of Congress from both parties signed a letter asking Barack Obama to strengthen his support for the President’s Emergency Plan for AIDS Relief, chiefly around the issue of Treatment as Prevention. Even at a time when the economy and partisan politics are consuming the domestic agenda, the U.S. has placed a priority on increasing the number of people on treatment from six million to 12 million worldwide by 2016.

Avoiding a national strategy costs all Canadians, financially, physically and emotionally. Research by the Canadian AIDS Society suggests the lifetime cost of each HIV infection is more than $425,000, including health care costs and lost productivity.

The case for support is very simple.

Every year, 3,300 men and women in Canada are diagnosed with HIV. An estimated 71,300 Canadians are now living with HIV, a number that could double within the next 15 years if the current rate of new infections continues and treatment is not expanded across Canada.

The federal government has a unique opportunity to turn around the HIV epidemic at all levels of Canadian society, if it implements Treatment as Prevention as a national strategy. We estimate Canada can realize a decrease in new HIV infections by at least 90 per cent in just five years if we fully implement this strategy.

It can be done; we’re doing it in B.C. If we can mobilize nationally and successfully to address issues like SARS, H1N1 and other pandemic diseases, we can do the same with HIV and AIDS.

The choice is ours. It’s time for Canada’s leaders to emulate the government of B.C. and adopt this as the national strategy to stop HIV/AIDS.

Dr. Julio Montaner is director of the British Columbia Centre for Excellence in HIV/AIDS, the Chair in AIDS Research and Head of Division of AIDS in the Faculty of Medicine, University of British Columbia, and past president of the International AIDS Society.

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